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	Sanjai Sharma, MD Sequoia Regional Cancer Center Visalia, CA, USA LinkedIn

This page contains histology-specific studies. For the more general classical Hodgkin lymphoma page, follow this link.

We have moved How I Treat articles to a dedicated page.

9 regimens on this page 11 variants on this page

Guidelines

Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.

JCO "Oncology Grand Rounds"

2020: Bartlett Treatment of Nodular Lymphocyte Hodgkin Lymphoma: The Goldilocks Principle PubMed

NCCN

NCCN does not currently have guidelines at this granular level; please see NCCN Guidelines - Hodgkin Lymphoma.

Untreated

ABVD

ABVD: Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine

Regimen

Study	Dates of enrollment	Evidence
Savage et al. 2011	1966-02 to 2009-05	Retrospective
Xing et al. 2014	1970-2011	Retrospective

Note: there are some reports of using rituximab although schedule & number of cycles is not well-established.

Chemotherapy

Doxorubicin (Adriamycin) 25 mg/m² IV once per day on days 1 & 15
Bleomycin (Blenoxane) 10 units/m² IV once per day on days 1 & 15 (1 unit test dose with cycle 1 doses, 60 minutes prior to remainder of full dose)
Vinblastine (Velban) 6 mg/m² IV once per day on days 1 & 15
Dacarbazine (DTIC) 375 mg/m² IV once per day on days 1 & 15

28-day cycle for 2 to 6 cycles based on stage, response, and whether radiation therapy is used.

References

Retrospective: Savage KJ, Skinnider B, Al-Mansour M, Sehn LH, Gascoyne RD, Connors JM. Treating limited-stage nodular lymphocyte predominant Hodgkin lymphoma similarly to classical Hodgkin lymphoma with ABVD may improve outcome. Blood. 2011 Oct 27;118(17):4585-90. Epub 2011 Aug 26. link to original article PubMed
Retrospective: Xing KH, Connors JM, Lai A, Al-Mansour M, Sehn LH, Villa D, Klasa R, Shenkier T, Gascoyne RD, Skinnider B, Savage KJ. Advanced-stage nodular lymphocyte predominant Hodgkin lymphoma compared with classical Hodgkin lymphoma: a matched pair outcome analysis. Blood. 2014 Jun 5;123(23):3567-73. Epub 2014 Apr 8. link to original article PubMed

CHOP

CHOP: Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Predniso(lo)ne

Regimen

Note: The below regimen was intended for DLBCL; no primary reference is to our knowledge available for use of CHOP in NLP-HL.

Chemotherapy

Cyclophosphamide (Cytoxan) 750 mg/m² IV once on day 1
Doxorubicin (Adriamycin) 50 mg/m² IV once on day 1
Vincristine (Oncovin) 1.4 mg/m² (maximum dose of 2 mg) IV once on day 1

Glucocorticoid therapy

Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5

21-day cycle for 6 to 8 cycles (number of cycles for CHOP in NLPHL is not well-established)

References

Feugier P, Van Hoof A, Sebban C, Solal-Celigny P, Bouabdallah R, Fermé C, Christian B, Lepage E, Tilly H, Morschhauser F, Gaulard P, Salles G, Bosly A, Gisselbrecht C, Reyes F, Coiffier B; Groupe d'Etude des Lymphomes de l'Adulte. Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d'Etude des Lymphomes de l'Adulte. J Clin Oncol. 2005 Jun 20;23(18):4117-26. link to original article dosing details in abstract have been reviewed by our editors PubMed

CVP (Vinblastine/Prednisolone)

CVP: Cyclophosphamide, Vinblastine, Prednisolone

Regimen

Study	Dates of enrollment	Evidence
Shankar et al. 2011	2005-06 to 2010-10	Retrospective

Note: contrary to most CVP regimens, this one uses vinblastine, not vincristine. This regimen was used in adolescents with early stage disease; note that there is a discrepancy between the abstract and the body of the manuscript regarding number of days that prednisolone is taken for.

Chemotherapy

Cyclophosphamide (Cytoxan) 500 mg/m² IV once on day 1
Vinblastine (Velban) 6 mg/m² IV once per day on days 1 & 8

Glucocorticoid therapy

Prednisolone (Millipred) 40 mg/m² PO once per day on days 1 to 8

14- to 21-day cycle for 3 cycles

References

Retrospective: Shankar A, Hall GW, Gorde-Grosjean S, Hasenclever D, Leblanc T, Hayward J, Lambilliotte A, Daw S, Perel Y, McCarthy K, Lejars O, Coulomb A, Oberlin WO, Wallace WH, Landman-Parker J. Treatment outcome after low intensity chemotherapy [CVP] in children and adolescents with early stage nodular lymphocyte predominant Hodgkin's lymphoma - an Anglo-French collaborative report. Eur J Cancer. 2012 Jul;48(11):1700-6. Epub 2011 Nov 15. link to original article dosing details in manuscript have been reviewed by our editors PubMed

EPOCH

EPOCH: Etoposide, Prednisone, Oncovin (Vincristine), Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin)

Regimen variant #1, Wilson et al. 1993 - original EPOCH protocol

Chemotherapy

Etoposide (Vepesid) 50 mg/m²/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 200 mg/m²)
Vincristine (Oncovin) 0.4 mg/m²/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 1.6 mg/m², sometimes capped at maximum total dose of 2 mg per cycle)
Doxorubicin (Adriamycin) 10 mg/m²/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 40 mg/m²)
Cyclophosphamide (Cytoxan) 750 mg/m² IV over 15 minutes once on day 5 (regimen originally was day 6, but now is day 5)

Glucocorticoid therapy

Prednisone (Sterapred) 60 mg/m²/day PO on days 1 to 5 (regimen originally was days 1 to 6, but now is just days 1 to 5)

Supportive therapy

PCP prophylaxis with one of the following:
- Trimethoprim-Sulfamethoxazole (Bactrim DS) 160/800 mg PO twice per day 3 days per week
- Atovaquone (Mepron) 1500 mg PO once per day
- Pentamidine (Nebupent) 300 mg nebulized once every 28 days
Filgrastim (Neupogen) 5 mcg/kg SC once per day, started on day 6 and continued until ANC greater than 5000/μL past nadir

21-day cycle for 6 to 8 cycles

Regimen variant #2, Wilson et al. 2002 - dose-adjusted EPOCH

Chemotherapy

Etoposide (Vepesid) 50 mg/m²/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 200 mg/m²)
Vincristine (Oncovin) 0.4 mg/m²/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 1.6 mg/m², sometimes capped at maximum total dose of 2 mg per cycle)
Doxorubicin (Adriamycin) 10 mg/m²/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 40 mg/m²)
Cyclophosphamide (Cytoxan) 750 mg/m² IV over 15 minutes once on day 5

Glucocorticoid therapy

Prednisone (Sterapred) 60 mg/m² PO twice per day on days 1 to 5

Supportive therapy

PCP prophylaxis with one of the following:
- Trimethoprim-Sulfamethoxazole (Bactrim DS) 160/800 mg PO twice per day 3 days per week
- Atovaquone (Mepron) 1500 mg PO once per day
- Pentamidine (Nebupent) 300 mg nebulized once every 28 days
Filgrastim (Neupogen) 5 mcg/kg SC once per day, started on day 6 and continued until ANC greater than 5000/μL past nadir

21-day cycle for 6 to 8 cycles

Dose and schedule modifications

Start cycle 1 as described above
Obtain twice per week CBCs for nadir measurements
If nadir ANC greater than 500/μL, increase Etoposide (Vepesid), Doxorubicin (Adriamycin), and Cyclophosphamide (Cytoxan) by 20% compared to previous cycle.
If nadir ANC less than 500/μL on 1 or 2 measurements, use same doses as last cycle
If nadir ANC less than 500/μL on at least 3 measurements, decrease Etoposide (Vepesid), Doxorubicin (Adriamycin), and Cyclophosphamide (Cytoxan) by 20% compared to previous cycle.
And/or if nadir platelet count less than 25 x 10⁹/L on at least 1 measurement, decrease Etoposide (Vepesid), Doxorubicin (Adriamycin), and Cyclophosphamide (Cytoxan) by 20% compared to previous cycle.
Dose adjustments below the cycle 1 starting dose only applies to cyclophosphamide. The lowest etoposide and doxorubicin would be dosed at is the original cycle 1 dose.
Can start new cycle Q21days if ANC greater than 1000/μL and platelets greater than 100 x 10⁹/L. If counts are below those levels, check daily CBC and continue growth factor support until counts are adequate and next cycle can start.

Historic dose adjustments for hematologic toxicity: These adjustments were in the original paper for standard EPOCH, which are much less relevant due to growth factor support.
If ANC on day 1 is:

greater than 1500/μL, full dose cyclophosphamide
1000 to 1500/μL, reduce cyclophosphamide by 187 mg/m² (equal to 25% dose reduction)
less than 1000/μL, hold EPOCH
If ANC nadir is less than 500/μL, reduce cyclophosphamide an additional 187 mg/m²
If ANC nadir is greater than 500/μL and patient had previously been dose-reduced, increase cyclophosphamide dose by 187 mg/m²

References

Wilson WH, Bryant G, Bates S, Fojo A, Wittes RE, Steinberg SM, Kohler DR, Jaffe ES, Herdt J, Cheson BD et al. EPOCH chemotherapy: toxicity and efficacy in relapsed and refractory non-Hodgkin's lymphoma. J Clin Oncol. 1993 Aug;11(8):1573-82. link to original article dosing details in abstract have been reviewed by our editors PubMed
Wilson WH, Grossbard ML, Pittaluga S, Cole D, Pearson D, Drbohlav N, Steinberg SM, Little RF, Janik J, Gutierrez M, Raffeld M, Staudt L, Cheson BD, Longo DL, Harris N, Jaffe ES, Chabner BA, Wittes R, Balis F. Dose-adjusted EPOCH chemotherapy for untreated large B-cell lymphomas: a pharmacodynamic approach with high efficacy. Blood. 2002 Apr 15;99(8):2685-93. link to original article dosing details in abstract have been reviewed by our editors PubMed content property of HemOnc.org
Wilson WH, Dunleavy K, Pittaluga S, Hegde U, Grant N, Steinberg SM, Raffeld M, Gutierrez M, Chabner BA, Staudt L, Jaffe ES, Janik JE. Phase II study of dose-adjusted EPOCH and rituximab in untreated diffuse large B-cell lymphoma with analysis of germinal center and post-germinal center biomarkers. J Clin Oncol. 2008 Jun 1;26(16):2717-24. link to original article link to PMC article PubMed

R-CHOP

R-CHOP: Rituximab, Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Predniso(lo)ne

Regimen

Study	Dates of enrollment	Evidence
Fanale et al. 2017	1995-2015	Retrospective

The below regimen was intended for DLBCL; to our knowledge there are no prospective trials of R-CHOP in NLP-HL.

Targeted therapy

Rituximab (Rituxan) 375 mg/m² IV once on day 1

Chemotherapy

Cyclophosphamide (Cytoxan) 750 mg/m² IV once on day 1
Doxorubicin (Adriamycin) 50 mg/m² IV once on day 1
Vincristine (Oncovin) 1.4 mg/m² (maximum dose of 2 mg) IV once on day 1

Glucocorticoid therapy

Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5

21-day cycle for 6 to 8 cycles

References

Retrospective: Fanale MA, Cheah CY, Rich A, Medeiros LJ, Lai CM, Oki Y, Romaguera JE, Fayad LE, Hagemeister FB, Samaniego F, Rodriguez MA, Neelapu SS, Lee HJ, Nastoupil L, Fowler NH, Turturro F, Westin JR, Wang ML, McLaughlin P, Pinnix CC, Milgrom SA, Dabaja B, Horowitz SB, Younes A. Encouraging activity for R-CHOP in advanced stage nodular lymphocyte-predominant Hodgkin lymphoma. Blood. 2017 Jul 27;130(4):472-477. Epub 2017 May 18. link to original article link to PMC article PubMed

R-CVP

R-CVP: Rituximab, Cyclophosphamide, Vincristine, Prednisone

Regimen

Targeted therapy

Rituximab (Rituxan) 375 mg/m² IV once on day 1

Chemotherapy

Cyclophosphamide (Cytoxan) 750 mg/m² IV once on day 1
Vincristine (Oncovin) 1.4 mg/m² (maximum dose of 2 mg) IV once on day 1

Glucocorticoid therapy

Prednisone (Sterapred) 40 mg/m² PO once per day on days 1 to 5

21-day cycle for up to 8 cycles (number of cycles for R-CVP in NLPHL is not well-established)

References

See references for CVP

R-EPOCH

R-EPOCH: Rituximab, Etoposide, Prednisone, Oncovin (Vincristine), Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin)

Regimen variant #1, Wilson et al. 1993 - original EPOCH protocol (which did not include rituximab)

Targeted therapy

Rituximab (Rituxan) 375 mg/m² IV once per cycle (usually given as outpatient due to reimbursement issues)

Chemotherapy

Etoposide (Vepesid) 50 mg/m²/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 200 mg/m²)
Vincristine (Oncovin) 0.4 mg/m²/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 1.6 mg/m², sometimes capped at maximum total dose of 2 mg per cycle)
Doxorubicin (Adriamycin) 10 mg/m²/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 40 mg/m²)
Cyclophosphamide (Cytoxan) 750 mg/m² IV over 15 minutes once on day 5 (regimen originally was day 6, but now is day 5)

Glucocorticoid therapy

Prednisone (Sterapred) 60 mg/m²/day PO on days 1 to 5 (regimen originally was days 1 to 6, but now is just days 1 to 5)

Supportive therapy

PCP prophylaxis with one of the following:
- Trimethoprim-Sulfamethoxazole (Bactrim DS) 160/800 mg PO twice per day 3 days per week
- Atovaquone (Mepron) 1500 mg PO once per day
- Pentamidine (Nebupent) 300 mg nebulized once every 28 days
Filgrastim (Neupogen) 5 mcg/kg SC once per day, started on day 6 and continued until ANC greater than 5000/μL past nadir

21-day cycle for 6 to 8 cycles

Regimen variant #2, Wilson et al. 2002 - dose-adjusted EPOCH

Targeted therapy

Rituximab (Rituxan) 375 mg/m² IV once per cycle (usually given as outpatient due to reimbursement issues)

Chemotherapy

Etoposide (Vepesid) 50 mg/m²/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 200 mg/m²)
Vincristine (Oncovin) 0.4 mg/m²/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 1.6 mg/m², sometimes capped at maximum total dose of 2 mg per cycle)
Cyclophosphamide (Cytoxan) 750 mg/m² IV over 15 minutes once on day 5
Doxorubicin (Adriamycin) 10 mg/m²/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 40 mg/m²)

Glucocorticoid therapy

Prednisone (Sterapred) 60 mg/m² PO twice per day on days 1 to 5

Supportive therapy

PCP prophylaxis with one of the following:
- Trimethoprim-Sulfamethoxazole (Bactrim DS) 160/800 mg PO twice per day 3 days per week
- Atovaquone (Mepron) 1500 mg PO once per day
- Pentamidine (Nebupent) 300 mg nebulized once every 28 days
Filgrastim (Neupogen) 5 mcg/kg SC once per day, started on day 6 and continued until ANC greater than 5000/μL past nadir

21-day cycle for 6 to 8 cycles

Dose and schedule modifications

Start cycle 1 as described above
Obtain twice per week CBCs for nadir measurements
If nadir ANC greater than 500/μL, increase etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle.
If nadir ANC less than 500/μL on 1 or 2 measurements, use same doses as last cycle
If nadir ANC less than 500/μL on at least 3 measurements, decrease etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle.
And/or if nadir platelet count less than 25 x 10⁹/L on at least 1 measurement, decrease etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle.
Dose adjustments below the cycle 1 starting dose only applies to cyclophosphamide. The lowest etoposide and doxorubicin would be dosed at is the original cycle 1 dose.
Can start new cycle Q21days if ANC greater than 1000/μL and platelets greater than 100 x 10⁹/L. If counts are below those levels, check daily CBC and continue growth factor support until counts are adequate and next cycle can start.

Dose modifications, historic dose adjustments for hematologic toxicity

These adjustments were in the original paper for standard EPOCH, which are much less relevant due to growth factor support.
If ANC on day 1 is:

Greater than 1500/μL, full dose cyclophosphamide
1000 to 1500/μL, reduce cyclophosphamide by 187 mg/m² (equal to 25% dose reduction)
less than 1000/μL, hold EPOCH
If ANC nadir is less than 500/μL, reduce cyclophosphamide an additional 187 mg/m²
If ANC nadir is greater than 500/μL and patient had previously been dose-reduced, increase cyclophosphamide dose by 187 mg/m²

References

See references for EPOCH

Rituximab monotherapy

Regimen

Study	Dates of enrollment	Evidence
Rehwald et al. 2003	1999-2002	Phase 2
Ekstrand et al. 2003	1999-2002	Phase 2
Advani et al. 2014 (U2082N)	1999-2006	Phase 2
Eichenauer et al. 2011 (GHSG RIPL)	2006-2007	Phase 2

Targeted therapy

Rituximab (Rituxan) 375 mg/m² IV once per day on days 1, 8, 15, 22

Supportive therapy

Acetaminophen (Tylenol) 650 mg PO once per day on days 1, 8, 15, 22; 30 minutes prior to rituximab
Diphenhydramine (Benadryl) 25 mg PO once per day on days 1, 8, 15, 22; 30 minutes prior to rituximab

4-week course

Subsequent treatment

U2082N, after protocol amendment: Rituximab maintenance

References

Rehwald U, Schulz H, Reiser M, Sieber M, Staak JO, Morschhauser F, Driessen C, Rudiger T, Muller-Hermelink K, Diehl V, Engert A; German Hodgkin Lymphoma Study Group (GHSG). Treatment of relapsed CD20+ Hodgkin lymphoma with the monoclonal antibody rituximab is effective and well tolerated: results of a phase 2 trial of the German Hodgkin Lymphoma Study Group. Blood. 2003 Jan 15;101(2):420-4. link to original article dosing details in manuscript have been reviewed by our editors PubMed
1. Update: Schulz H, Rehwald U, Morschhauser F, Elter T, Driessen C, Rüdiger T, Borchmann P, Schnell R, Diehl V, Engert A, Reiser M. Rituximab in relapsed lymphocyte-predominant Hodgkin lymphoma: long-term results of a phase 2 trial by the German Hodgkin Lymphoma Study Group (GHSG). Blood. 2008 Jan 1;111(1):109-11. Epub 2007 Oct 15. link to original article dosing details in abstract have been reviewed by our editors PubMed
Ekstrand BC, Lucas JB, Horwitz SM, Fan Z, Breslin S, Hoppe RT, Natkunam Y, Bartlett NL, Horning SJ. Rituximab in lymphocyte-predominant Hodgkin disease: results of a phase 2 trial. Blood. 2003 Jun 1;101(11):4285-9. Epub 2003 Feb 13. link to original article dosing details in abstract have been reviewed by our editors PubMed
GHSG RIPL: Eichenauer DA, Fuchs M, Pluetschow A, Klimm B, Halbsguth T, Böll B, von Tresckow B, Nogová L, Borchmann P, Engert A. Phase 2 study of rituximab in newly diagnosed stage IA nodular lymphocyte-predominant Hodgkin lymphoma: a report from the German Hodgkin Study Group. Blood. 2011 Oct 20;118(16):4363-5. Epub 2011 Aug 9. link to original article dosing details in abstract have been reviewed by our editors PubMed NCT00346684
U2082N: Advani RH, Horning SJ, Hoppe RT, Daadi S, Allen J, Natkunam Y, Bartlett NL. Mature results of a phase II study of rituximab therapy for nodular lymphocyte-predominant Hodgkin lymphoma. J Clin Oncol. 2014 Mar 20;32(9):912-8. Epub 2014 Feb 10. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00003820

Maintenance after upfront therapy

Rituximab monotherapy

Regimen

Study	Dates of enrollment	Evidence
Advani et al. 2014 (U2082N)	1999-2006	Phase 2, fewer than 20 patients in this arm

Preceding treatment

Rituximab induction x 4

Targeted therapy

Rituximab (Rituxan) 375 mg/m² IV once per day on days 1, 8, 15, 22

6-month cycle for 4 cycles (2 years)

References

U2082N: Advani RH, Horning SJ, Hoppe RT, Daadi S, Allen J, Natkunam Y, Bartlett NL. Mature results of a phase II study of rituximab therapy for nodular lymphocyte-predominant Hodgkin lymphoma. J Clin Oncol. 2014 Mar 20;32(9):912-8. Epub 2014 Feb 10. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00003820

@@ Line 1: / Line 1: @@
-'''Use of this site is subject to you reading and agreeing with the terms set forth in the [[HemOnc.org_-_A_Hematology_Oncology_Wiki:General_disclaimer|disclaimer]].'''
+<span id="BackToTop"></span>
+<div class="noprint" style="background-color:LightGray; position:fixed; bottom:2%; right:0.25%; padding-left:5px; padding-right:5px; margin: 15px; opacity:0.8; border-style: solid; border-color:DarkGray; border-width: 1px">
-Is there a regimen missing from this list?  Would you like to share a different dosage/schedule or an additional reference for a regimen?  Have you noticed an error?  Do you have an idea that will help the site grow to better meet your needs and the needs of many others?  You are [[How_to_contribute|invited to contribute to the site]].
+[[#top|Back to Top]]
+</div>
+{{#lst:Editorial board transclusions|inhl}}
+''This page contains histology-specific studies. For the more general classical Hodgkin lymphoma page, follow [[Classical Hodgkin lymphoma|this link]].
+*''We have moved [[How I Treat]] articles to a dedicated page.''
 {| class="wikitable" style="float:right; margin-right: 5px;"
 |-
-|<div style="background-color: #66FF66; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}" align="right"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Regimen |limit=10000|format=sum}} regimens on this page</b></font></div>
+|<div style="background-color: #fee0d1; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}" align="right"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Regimen |limit=10000|format=sum}} [[Tutorial#Regimens|regimens]] on this page</b></font></div>
-<div style="background-color: #66CCFF; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Variant |limit=10000|format=sum}} variants on this page</b></font></div>
+<div style="background-color: #deebf6; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Variant |limit=10000|format=sum}} [[Tutorial#Variants|variants]] on this page</b></font></div>
 |}
 {{TOC limit|limit=3}}
+=Guidelines=
+'''Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.'''
+==JCO "Oncology Grand Rounds"==
+*'''2020:''' Bartlett [https://doi.org/10.1200/jco.19.02816 Treatment of Nodular Lymphocyte Hodgkin Lymphoma: The Goldilocks Principle] [https://pubmed.ncbi.nlm.nih.gov/31922929 PubMed]
+==NCCN==
+*''NCCN does not currently have guidelines at this granular level; please see [https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1439 NCCN Guidelines - Hodgkin Lymphoma].''
 =Untreated=
 ==ABVD {{#subobject:4c2988|Regimen=1}}==
-{| class="wikitable" style="float:right; margin-left: 5px;"
-|-
-|[[#toc|back to top]]
-|}
 ABVD: '''<u>A</u>'''driamycin (Doxorubicin), '''<u>B</u>'''leomycin, '''<u>V</u>'''inblastine, '''<u>D</u>'''acarbazine
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:c0fc65|Variant=1}}===
-{| border="1" style="text-align:center;" !align="left"
+{| class="wikitable sortable" style="width: 60%; text-align:center;"
-|'''Study'''
+!style="width: 33%"|Study
-|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+!style="width: 33%"|Dates of enrollment
-|-
+!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
-|[http://bloodjournal.hematologylibrary.org/content/118/17/4585.long Savage et al. 2011]
-|<span
-style="background:#ff0000;
-padding:3px 6px 3px 6px;
-border-color:black;
-border-width:2px;
-border-style:solid;">Retrospective</span>
 |-
-!colspan="4" align="center"|
+|[https://doi.org/10.1182/blood-2011-07-365932 Savage et al. 2011]
+|1966-02 to 2009-05
+|style="background-color:#ffffbe"|Retrospective
 |-
-|[http://www.bloodjournal.org/content/123/23/3567.long Xing et al. 2014]
+|[https://doi.org/10.1182/blood-2013-12-541078 Xing et al. 2014]
-|<span
+|1970-2011
-style="background:#ff0000;
+|style="background-color:#ffffbe"|Retrospective
-padding:3px 6px 3px 6px;
-border-color:black;
-border-width:2px;
-border-style:solid;">Retrospective</span>
 |-
 |}
-*[[Doxorubicin (Adriamycin)]] 25 mg/m2 IV once per day on days 1 & 15
+''Note: there are some reports of using rituximab although schedule & number of cycles is not well-established.
-*[[Bleomycin (Blenoxane)]] 10 units/m2 IV once per day on days 1 & 15 (1 unit test dose with cycle 1 doses, 60 minutes prior to remainder of full dose)
+<div class="toccolours" style="background-color:#b3e2cd">
-*[[Vinblastine (Velban)]] 6 mg/m2 IV once per day on days 1 & 15
+====Chemotherapy====
-*[[Dacarbazine (DTIC)]] 375 mg/m2 IV once per day on days 1 & 15
+*[[Doxorubicin (Adriamycin)]] 25 mg/m<sup>2</sup> IV once per day on days 1 & 15
-*+/- [[Rituximab (Rituxan)]]; schedule & number of cycles is not well-established. One potential option is 375 mg/m2 IV weekly x 4 weeks on cycle 1 (see [[#Single_agent_Rituximab_.28Rituxan.29|single agent rituximab]]). Use in subsequent cycles is not well-documented.
+*[[Bleomycin (Blenoxane)]] 10 units/m<sup>2</sup> IV once per day on days 1 & 15 (1 unit test dose with cycle 1 doses, 60 minutes prior to remainder of full dose)
+*[[Vinblastine (Velban)]] 6 mg/m<sup>2</sup> IV once per day on days 1 & 15
-'''28-day cycle x 2 to 6 cycles''' based on stage, response, and whether radiation therapy is used.
+*[[Dacarbazine (DTIC)]] 375 mg/m<sup>2</sup> IV once per day on days 1 & 15
+'''28-day cycle for 2 to 6 cycles''' based on stage, response, and whether radiation therapy is used.
+</div></div>
 ===References===
-# '''Retrospective:''' Savage KJ, Skinnider B, Al-Mansour M, Sehn LH, Gascoyne RD, Connors JM. Treating limited-stage nodular lymphocyte predominant Hodgkin lymphoma similarly to classical Hodgkin lymphoma with ABVD may improve outcome. Blood. 2011 Oct 27;118(17):4585-90. [http://bloodjournal.hematologylibrary.org/content/118/17/4585.long link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/21873543 PubMed]
+# '''Retrospective:''' Savage KJ, Skinnider B, Al-Mansour M, Sehn LH, Gascoyne RD, Connors JM. Treating limited-stage nodular lymphocyte predominant Hodgkin lymphoma similarly to classical Hodgkin lymphoma with ABVD may improve outcome. Blood. 2011 Oct 27;118(17):4585-90. Epub 2011 Aug 26. [https://doi.org/10.1182/blood-2011-07-365932 link to original article] [https://pubmed.ncbi.nlm.nih.gov/21873543/ PubMed]
-# '''Retrospective:''' Xing KH, Connors JM, Lai A, Al-Mansour M, Sehn LH, Villa D, Klasa R, Shenkier T, Gascoyne RD, Skinnider B, Savage KJ. Advanced-stage nodular lymphocyte predominant Hodgkin lymphoma compared with classical Hodgkin lymphoma: a matched pair outcome analysis. Blood. 2014 Jun 5;123(23):3567-73. Epub 2014 Apr 8. [http://www.bloodjournal.org/content/123/23/3567.long link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/24713929 PubMed]
+# '''Retrospective:''' Xing KH, Connors JM, Lai A, Al-Mansour M, Sehn LH, Villa D, Klasa R, Shenkier T, Gascoyne RD, Skinnider B, Savage KJ. Advanced-stage nodular lymphocyte predominant Hodgkin lymphoma compared with classical Hodgkin lymphoma: a matched pair outcome analysis. Blood. 2014 Jun 5;123(23):3567-73. Epub 2014 Apr 8. [https://doi.org/10.1182/blood-2013-12-541078 link to original article] [https://pubmed.ncbi.nlm.nih.gov/24713929/ PubMed]
 ==CHOP {{#subobject:4f07a9|Regimen=1}}==
-{| class="wikitable" style="float:right; margin-left: 5px;"
+CHOP: '''<u>C</u>'''yclophosphamide, '''<u>H</u>'''ydroxydaunorubicin (Doxorubicin), '''<u>O</u>'''ncovin (Vincristine), '''<u>P</u>'''redniso(lo)ne
-|-
+<div class="toccolours" style="background-color:#eeeeee">
-|[[#toc|back to top]]
-|}
-CHOP: '''<u>C</u>'''yclophosphamide, '''<u>H</u>'''ydroxydaunorubicin (Doxorubicin), '''<u>O</u>'''ncovin (Vincristine), '''<u>P</u>'''rednisone
 ===Regimen {{#subobject:7bb950|Variant=1}}===
-''The below regimen was intended for [[Diffuse large B-cell lymphoma|DLBCL]]; no primary reference is to our knowledge available for use of CHOP in NLP-HL.''
+''Note: The below regimen was intended for [[Diffuse large B-cell lymphoma|DLBCL]]; no primary reference is to our knowledge available for use of CHOP in NLP-HL.''
+<div class="toccolours" style="background-color:#b3e2cd">
-*[[Cyclophosphamide (Cytoxan)]] 750 mg/m2 IV once on day 1
+====Chemotherapy====
-*[[Doxorubicin (Adriamycin)]] 50 mg/m2 IV once on day 1
+*[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV once on day 1
-*[[Vincristine (Oncovin)]] 1.4 mg/m2 (maximum dose of 2mg per cycle) IV once on day 1
+*[[Doxorubicin (Adriamycin)]] 50 mg/m<sup>2</sup> IV once on day 1
+*[[Vincristine (Oncovin)]] 1.4 mg/m<sup>2</sup> (maximum dose of 2 mg) IV once on day 1
+====Glucocorticoid therapy====
 *[[Prednisone (Sterapred)]] 100 mg PO once per day on days 1 to 5
+'''21-day cycle for 6 to 8 cycles''' (number of cycles for CHOP in NLPHL is not well-established)
-'''21-day cycle x 6 to 8 cycles''' (number of cycles for CHOP in NLPHL is not well-established)
+</div></div>
 ===References===
-# Feugier P, Van Hoof A, Sebban C, Solal-Celigny P, Bouabdallah R, Fermé C, Christian B, Lepage E, Tilly H, Morschhauser F, Gaulard P, Salles G, Bosly A, Gisselbrecht C, Reyes F, Coiffier B. Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d'Etude des Lymphomes de l'Adulte. J Clin Oncol. 2005 Jun 20;23(18):4117-26. [http://jco.ascopubs.org/content/23/18/4117.full link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/15867204 PubMed]
+# Feugier P, Van Hoof A, Sebban C, Solal-Celigny P, Bouabdallah R, Fermé C, Christian B, Lepage E, Tilly H, Morschhauser F, Gaulard P, Salles G, Bosly A, Gisselbrecht C, Reyes F, Coiffier B; Groupe d'Etude des Lymphomes de l'Adulte. Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d'Etude des Lymphomes de l'Adulte. J Clin Oncol. 2005 Jun 20;23(18):4117-26. [https://doi.org/10.1200/jco.2005.09.131 link to original article] '''dosing details in abstract have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/15867204/ PubMed]
+==CVP (Vinblastine/Prednisolone) {{#subobject:55d745|Regimen=1}}==
-==CVP {{#subobject:55d745|Regimen=1}}==
+CVP: '''<u>C</u>'''yclophosphamide, '''<u>V</u>'''inblastine, '''<u>P</u>'''rednisolone
-{| class="wikitable" style="float:right; margin-left: 5px;"
+<div class="toccolours" style="background-color:#eeeeee">
+===Regimen {{#subobject:8938af|Variant=1}}===
+{| class="wikitable sortable" style="width: 60%; text-align:center;"
+!style="width: 33%"|Study
+!style="width: 33%"|Dates of enrollment
+!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
+|-
+|[https://doi.org/10.1016/j.ejca.2011.10.018 Shankar et al. 2011]
+|2005-06 to 2010-10
+|style="background-color:#ffffbe"|Retrospective
 |-
-|[[#toc|back to top]]
 |}
-CVP: '''<u>C</u>'''yclophosphamide, '''<u>V</u>'''incristine, '''<u>P</u>'''rednisone
+''Note: contrary to most CVP regimens, this one uses vinblastine, not vincristine. This regimen was used in adolescents with early stage disease; note that there is a discrepancy between the abstract and the body of the manuscript regarding number of days that prednisolone is taken for.''
-===Regimen {{#subobject:8938af|Variant=1}}===
+<div class="toccolours" style="background-color:#b3e2cd">
-''The below regimen was intended for [[Follicular lymphoma|follicular lymphoma]]; no primary reference is to our knowledge available for use of CVP in NLP-HL.''
+====Chemotherapy====
+*[[Cyclophosphamide (Cytoxan)]] 500 mg/m<sup>2</sup> IV once on day 1
-*[[Cyclophosphamide (Cytoxan)]] 750 mg/m2 IV once on day 1
+*[[Vinblastine (Velban)]] 6 mg/m<sup>2</sup> IV once per day on days 1 & 8
-*[[Vincristine (Oncovin)]] 1.4 mg/m2 (maximum dose of 2mg per cycle) IV once on day 1
+====Glucocorticoid therapy====
-*[[Prednisone (Sterapred)]] 40 mg/m2 PO once per day on days 1 to 5
+*[[Prednisolone (Millipred)]] 40 mg/m<sup>2</sup> PO once per day on days 1 to 8
+'''14- to 21-day cycle for 3 cycles'''
-'''21-day cycles x up to 8 cycles''' (number of cycles for CVP in NLPHL is not well-established)
+</div></div>
 ===References===
-# Marcus R, Imrie K, Belch A, Cunningham D, Flores E, Catalano J, Solal-Celigny P, Offner F, Walewski J, Raposo J, Jack A, Smith P. CVP chemotherapy plus rituximab compared with CVP as first-line treatment for advanced follicular lymphoma. Blood. 2005 Feb 15;105(4):1417-23. [http://bloodjournal.hematologylibrary.org/content/105/4/1417.full link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/15494430 PubMed]
+# '''Retrospective:''' Shankar A, Hall GW, Gorde-Grosjean S, Hasenclever D, Leblanc T, Hayward J, Lambilliotte A, Daw S, Perel Y, McCarthy K, Lejars O, Coulomb A, Oberlin WO, Wallace WH, Landman-Parker J. Treatment outcome after low intensity chemotherapy [CVP] in children and adolescents with early stage nodular lymphocyte predominant Hodgkin's lymphoma - an Anglo-French collaborative report. Eur J Cancer. 2012 Jul;48(11):1700-6. Epub 2011 Nov 15. [https://doi.org/10.1016/j.ejca.2011.10.018 link to original article] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/22093944/ PubMed]
 ==EPOCH {{#subobject:7022de|Regimen=1}}==
-{| class="wikitable" style="float:right; margin-left: 5px;"
-|-
-|[[#toc|back to top]]
-|}
 EPOCH: '''<u>E</u>'''toposide, '''<u>P</u>'''rednisone, '''<u>O</u>'''ncovin (Vincristine), '''<u>C</u>'''yclophosphamide, '''<u>H</u>'''ydroxydaunorubicin (Doxorubicin)
+<div class="toccolours" style="background-color:#eeeeee">
-===Regimen #1, Wilson et al. 1993 - original EPOCH protocol {{#subobject:1eb77a|Variant=1}}===
+===Regimen variant #1, Wilson et al. 1993 - original EPOCH protocol {{#subobject:1eb77a|Variant=1}}===
-*[[Etoposide (Vepesid)]] 50 mg/m2/day (200 mg/m2 total) IV continuous infusion on days 1 to 4
+<div class="toccolours" style="background-color:#b3e2cd">
-*[[Prednisone (Sterapred)]] 60 mg/m2/day PO on days 1 to 5 (regimen originally was days 1 to 6, but now is just days 1 to 5)
+====Chemotherapy====
-*[[Vincristine (Oncovin)]] 0.4 mg/m2/day (1.6 mg/m2 total) (sometimes capped at maximum total dose of 2mg per cycle) IV continuous infusion on days 1 to 4
+*[[Etoposide (Vepesid)]] 50 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 200 mg/m<sup>2</sup>)
-*[[Doxorubicin (Adriamycin)]] 10 mg/m2/day (40 mg/m2 total) IV continuous infusion on days 1 to 4
+*[[Vincristine (Oncovin)]] 0.4 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 1.6 mg/m<sup>2</sup>, sometimes capped at maximum total dose of 2 mg per cycle)
-*[[Cyclophosphamide (Cytoxan)]] 750 mg/m2 IV over 15 minutes on day 5 (regimen originally was day 6, but now is day 5)
+*[[Doxorubicin (Adriamycin)]] 10 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 40 mg/m<sup>2</sup>)
+*[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV over 15 minutes once on day 5 (regimen originally was day 6, but now is day 5)
-Supportive medications:
+====Glucocorticoid therapy====
-*PCP prophylaxis (choose one)
+*[[Prednisone (Sterapred)]] 60 mg/m<sup>2</sup>/day PO on days 1 to 5 (regimen originally was days 1 to 6, but now is just days 1 to 5)
-**[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (160/800 mg) PO BID 3 days per week
+====Supportive therapy====
-**[[Atovaquone (Mepron)]] 1500 mg PO daily
+*PCP prophylaxis with one of the following:
-**[[Pentamidine (Nebupent)]] 300 mg nebulized Q28days
+**[[Trimethoprim-Sulfamethoxazole (Bactrim DS)]] 160/800 mg PO twice per day 3 days per week
-*[[Filgrastim (Neupogen)]] 5 mcg/kg SQ daily start day 6 and continue until ANC >5,000/uL past nadir
+**[[Atovaquone (Mepron)]] 1500 mg PO once per day
+**[[Pentamidine (Nebupent)]] 300 mg nebulized once every 28 days
-'''21-day cycles x 6 to 8 cycles'''
+*[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day, started on day 6 and continued until ANC greater than 5000/μL past nadir
+'''21-day cycle for 6 to 8 cycles'''
-===Regimen #2, Wilson et al. 2002 - dose-adjusted EPOCH {{#subobject:77d453|Variant=1}}===
+</div></div><br>
-*[[Etoposide (Vepesid)]] 50 mg/m2/day (200 mg/m2 total) IV continuous infusion on days 1 to 4
+<div class="toccolours" style="background-color:#eeeeee">
-*[[Prednisone (Sterapred)]] 60 mg/m2 PO BID on days 1 to 5
+===Regimen variant #2, Wilson et al. 2002 - dose-adjusted EPOCH {{#subobject:77d453|Variant=1}}===
-*[[Vincristine (Oncovin)]] 0.4 mg/m2/day (1.6 mg/m2 total) (not capped in the paper, but sometimes capped at a maximum total dose of 2mg per cycle) IV continuous infusion on days 1 to 4
+<div class="toccolours" style="background-color:#b3e2cd">
-*[[Doxorubicin (Adriamycin)]] 10 mg/m2/day (40 mg/m2 total) IV continuous infusion on days 1 to 4
+====Chemotherapy====
-*[[Cyclophosphamide (Cytoxan)]] 750 mg/m2 IV over 15 minutes on day 5
+*[[Etoposide (Vepesid)]] 50 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 200 mg/m<sup>2</sup>)
+*[[Vincristine (Oncovin)]] 0.4 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 1.6 mg/m<sup>2</sup>, sometimes capped at maximum total dose of 2 mg per cycle)
-Supportive medications:
+*[[Doxorubicin (Adriamycin)]] 10 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 40 mg/m<sup>2</sup>)
-*PCP prophylaxis (choose one)
+*[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV over 15 minutes once on day 5
-**[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (160/800 mg) PO BID 3 days per week
+====Glucocorticoid therapy====
-**[[Atovaquone (Mepron)]] 1500 mg PO daily
+*[[Prednisone (Sterapred)]] 60 mg/m<sup>2</sup> PO twice per day on days 1 to 5
-**[[Pentamidine (Nebupent)]] 300 mg nebulized Q28days
+====Supportive therapy====
-*[[Filgrastim (Neupogen)]] 5 mcg/kg SQ daily start day 6 and continue until ANC >5,000/uL past nadir
+*PCP prophylaxis with one of the following:
+**[[Trimethoprim-Sulfamethoxazole (Bactrim DS)]] 160/800 mg PO twice per day 3 days per week
-'''21-day cycles x 6 to 8 cycles'''
+**[[Atovaquone (Mepron)]] 1500 mg PO once per day
+**[[Pentamidine (Nebupent)]] 300 mg nebulized once every 28 days
-Dose-adjustments for EPOCH protocol:
+*[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day, started on day 6 and continued until ANC greater than 5000/μL past nadir
+'''21-day cycle for 6 to 8 cycles'''
+</div>
+<div class="toccolours" style="background-color:#fff2ae">
+====Dose and schedule modifications====
 *Start cycle 1 as described above
 *Obtain twice per week CBCs for nadir measurements
-*If nadir ANC >500, increase [[Etoposide (Vepesid)]], [[Doxorubicin (Adriamycin)]], and [[Cyclophosphamide (Cytoxan)]] by 20% compared to previous cycle.
+*If nadir ANC greater than 500/μL, increase [[Etoposide (Vepesid)]], [[Doxorubicin (Adriamycin)]], and [[Cyclophosphamide (Cytoxan)]] by 20% compared to previous cycle.
-*If nadir ANC <500 on 1 or 2 measurements, use same doses as last cycle
+*If nadir ANC less than 500/μL on 1 or 2 measurements, use same doses as last cycle
-*If nadir ANC <500 on at least 3 measurements, decrease [[Etoposide (Vepesid)]], [[Doxorubicin (Adriamycin)]], and [[Cyclophosphamide (Cytoxan)]] by 20% compared to previous cycle.
+*If nadir ANC less than 500/μL on at least 3 measurements, decrease [[Etoposide (Vepesid)]], [[Doxorubicin (Adriamycin)]], and [[Cyclophosphamide (Cytoxan)]] by 20% compared to previous cycle.
-*And/or if nadir platelet count <25 on at least 1 measurement, decrease [[Etoposide (Vepesid)]], [[Doxorubicin (Adriamycin)]], and [[Cyclophosphamide (Cytoxan)]] by 20% compared to previous cycle.
+*And/or if nadir platelet count less than 25 x 10<sup>9</sup>/L on at least 1 measurement, decrease [[Etoposide (Vepesid)]], [[Doxorubicin (Adriamycin)]], and [[Cyclophosphamide (Cytoxan)]] by 20% compared to previous cycle.
-*'''Dose adjustments below the cycle 1 starting dose only applies to cyclophosphamide.'''  The lowest etoposide and doxorubicin would be dosed at is the original cycle 1 dose.
+*'''Dose adjustments below the cycle 1 starting dose only applies to cyclophosphamide.''' The lowest etoposide and doxorubicin would be dosed at is the original cycle 1 dose.
-*Can start new cycle Q21days if ANC >1,000 and platelets >100.  If counts are below those levels, check daily CBC and continue growth factor support until counts are adequate and next cycle can start.
+*Can start new cycle Q21days if ANC greater than 1000/μL and platelets greater than 100 x 10<sup>9</sup>/L. If counts are below those levels, check daily CBC and continue growth factor support until counts are adequate and next cycle can start.
 Historic dose adjustments for hematologic toxicity:
 These adjustments were in the original paper for standard EPOCH, which are much less relevant due to growth factor support.
 <br>If ANC on day 1 is:
-* >1,500, full dose cyclophosphamide
+* greater than 1500/μL, full dose cyclophosphamide
-* 1,000-1,500, reduce cyclophosphamide by 187 mg/m2 (equal to 25% dose reduction)
+* 1000 to 1500/μL, reduce cyclophosphamide by 187 mg/m<sup>2</sup> (equal to 25% dose reduction)
-* <1,000, hold EPOCH
+* less than 1000/μL, hold EPOCH
-*If ANC nadir is <500, reduce cyclophosphamide an additional 187 mg/m2
+*If ANC nadir is less than 500/μL, reduce cyclophosphamide an additional 187 mg/m<sup>2</sup>
-*If ANC nadir is >500 and patient had previously been dose-reduced, increase cyclophosphamide dose by 187 mg/m2
+*If ANC nadir is greater than 500/μL and patient had previously been dose-reduced, increase cyclophosphamide dose by 187 mg/m<sup>2</sup>
+</div></div>
 ===References===
-# Wilson WH, Bryant G, Bates S, Fojo A, Wittes RE, Steinberg SM, Kohler DR, Jaffe ES, Herdt J, Cheson BD et al. EPOCH chemotherapy: toxicity and efficacy in relapsed and refractory non-Hodgkin's lymphoma. J Clin Oncol. 1993 Aug;11(8):1573-82 [http://jco.ascopubs.org/content/11/8/1573.long link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/7687667 PubMed]
+# Wilson WH, Bryant G, Bates S, Fojo A, Wittes RE, Steinberg SM, Kohler DR, Jaffe ES, Herdt J, Cheson BD et al. EPOCH chemotherapy: toxicity and efficacy in relapsed and refractory non-Hodgkin's lymphoma. J Clin Oncol. 1993 Aug;11(8):1573-82. [https://doi.org/10.1200/jco.1993.11.8.1573 link to original article] '''dosing details in abstract have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/7687667/ PubMed]
-# Wilson WH, Grossbard ML, Pittaluga S, Cole D, Pearson D, Drbohlav N, Steinberg SM, Little RF, Janik J, Gutierrez M, Raffeld M, Staudt L, Cheson BD, Longo DL, Harris N, Jaffe ES, Chabner BA, Wittes R, Balis F. Dose-adjusted EPOCH chemotherapy for untreated large B-cell lymphomas: a pharmacodynamic approach with high efficacy. Blood. 2002 Apr 15;99(8):2685-93. [http://bloodjournal.hematologylibrary.org/content/99/8/2685.long link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/11929754 PubMed] content property of [http://hemonc.org HemOnc.org]
+# Wilson WH, Grossbard ML, Pittaluga S, Cole D, Pearson D, Drbohlav N, Steinberg SM, Little RF, Janik J, Gutierrez M, Raffeld M, Staudt L, Cheson BD, Longo DL, Harris N, Jaffe ES, Chabner BA, Wittes R, Balis F. Dose-adjusted EPOCH chemotherapy for untreated large B-cell lymphomas: a pharmacodynamic approach with high efficacy. Blood. 2002 Apr 15;99(8):2685-93. [https://doi.org/10.1182/blood.v99.8.2685 link to original article] '''dosing details in abstract have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/11929754/ PubMed] content property of [https://hemonc.org HemOnc.org]
-# Wilson WH, Dunleavy K, Pittaluga S, Hegde U, Grant N, Steinberg SM, Raffeld M, Gutierrez M, Chabner BA, Staudt L, Jaffe ES, Janik JE. Phase II study of dose-adjusted EPOCH and rituximab in untreated diffuse large B-cell lymphoma with analysis of germinal center and post-germinal center biomarkers. J Clin Oncol. 2008 Jun 1;26(16):2717-24. [http://jco.ascopubs.org/content/26/16/2717.long link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/18378569 PubMed]
+# Wilson WH, Dunleavy K, Pittaluga S, Hegde U, Grant N, Steinberg SM, Raffeld M, Gutierrez M, Chabner BA, Staudt L, Jaffe ES, Janik JE. Phase II study of dose-adjusted EPOCH and rituximab in untreated diffuse large B-cell lymphoma with analysis of germinal center and post-germinal center biomarkers. J Clin Oncol. 2008 Jun 1;26(16):2717-24. [https://doi.org/10.1200/jco.2007.13.1391 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2409217/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/18378569/ PubMed]
 ==R-CHOP {{#subobject:49e0e5|Regimen=1}}==
-{| class="wikitable" style="float:right; margin-left: 5px;"
+R-CHOP: '''<u>R</u>'''ituximab, '''<u>C</u>'''yclophosphamide, '''<u>H</u>'''ydroxydaunorubicin (Doxorubicin), '''<u>O</u>'''ncovin (Vincristine), '''<u>P</u>'''redniso(lo)ne
-|-
+<div class="toccolours" style="background-color:#eeeeee">
-|[[#toc|back to top]]
-|}
-R-CHOP: '''<u>R</u>'''ituximab, '''<u>C</u>'''yclophosphamide, '''<u>H</u>'''ydroxydaunorubicin (Doxorubicin), '''<u>O</u>'''ncovin (Vincristine), '''<u>P</u>'''rednisone
 ===Regimen {{#subobject:2bb1cd|Variant=1}}===
-{| border="1" style="text-align:center;" !align="left"
+{| class="wikitable sortable" style="width: 60%; text-align:center;"
-|'''Study'''
+!style="width: 33%"|Study
-|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+!style="width: 33%"|Dates of enrollment
+!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
 |-
-|[http://abstracts.hematologylibrary.org/cgi/content/abstract/116/21/2812 Fanale et al. 2010]
+|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5578726/ Fanale et al. 2017]
-|<span
+|1995-2015
-style="background:#ff0000;
+|style="background-color:#ffffbe"|Retrospective
-padding:3px 6px 3px 6px;
-border-color:black;
-border-width:2px;
-border-style:solid;">Retrospective</span>
 |-
 |}
-''The below regimen was intended for [[Diffuse large B-cell lymphoma|DLBCL]]; no prospective reference is to our knowledge available for use of R-CHOP in NLP-HL.''
+''The below regimen was intended for [[Diffuse large B-cell lymphoma|DLBCL]]; to our knowledge there are no prospective trials of R-CHOP in NLP-HL.''
+<div class="toccolours" style="background-color:#b3e2cd">
-*[[Rituximab (Rituxan)]] 375 mg/m2 IV once on day 1
+====Targeted therapy====
-*[[Cyclophosphamide (Cytoxan)]] 750 mg/m2 IV once on day 1
+*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
-*[[Doxorubicin (Adriamycin)]] 50 mg/m2 IV once on day 1
+====Chemotherapy====
-*[[Vincristine (Oncovin)]] 1.4 mg/m2 (maximum dose of 2mg per cycle) IV once on day 1
+*[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV once on day 1
+*[[Doxorubicin (Adriamycin)]] 50 mg/m<sup>2</sup> IV once on day 1
+*[[Vincristine (Oncovin)]] 1.4 mg/m<sup>2</sup> (maximum dose of 2 mg) IV once on day 1
+====Glucocorticoid therapy====
 *[[Prednisone (Sterapred)]] 100 mg PO once per day on days 1 to 5
+'''21-day cycle for 6 to 8 cycles'''
-'''21-day cycle x 6 to 8 cycles'''
+</div></div>
 ===References===
-# '''Retrospective Abstract:''' Fanale, Michelle A., Lai, Chao-Ming, McLaughlin, Peter, Romaguera, Jorge, Fayad, Luis, Hagemeister, Fredrick, Samaniego, Felipe, Rodriguez, Maria Alma, Neelapu, Sattva S., Shah, Jatin J, Kwak, Larry, Dong, Wenli, Reed, Valerie, Dabaja, Bouthaina S., Popat, Uday, Younes, Anas. Outcomes of Nodular Lymphocyte Predominant Hodgkin's Lymphoma (NLPHL) Patients Treated with R-CHOP. ASH Annual Meeting Abstracts 2010 116: 2812 [http://abstracts.hematologylibrary.org/cgi/content/abstract/116/21/2812 link to abstract]
+<!-- # '''Retrospective Abstract:''' Fanale, Michelle A., Lai, Chao-Ming, McLaughlin, Peter, Romaguera, Jorge, Fayad, Luis, Hagemeister, Fredrick, Samaniego, Felipe, Rodriguez, Maria Alma, Neelapu, Sattva S., Shah, Jatin J, Kwak, Larry, Dong, Wenli, Reed, Valerie, Dabaja, Bouthaina S., Popat, Uday, Younes, Anas. Outcomes of Nodular Lymphocyte Predominant Hodgkin's Lymphoma (NLPHL) Patients Treated with R-CHOP. ASH Annual Meeting Abstracts 2010 116: 2812-->
+# '''Retrospective:''' Fanale MA, Cheah CY, Rich A, Medeiros LJ, Lai CM, Oki Y, Romaguera JE, Fayad LE, Hagemeister FB, Samaniego F, Rodriguez MA, Neelapu SS, Lee HJ, Nastoupil L, Fowler NH, Turturro F, Westin JR, Wang ML, McLaughlin P, Pinnix CC, Milgrom SA, Dabaja B, Horowitz SB, Younes A. Encouraging activity for R-CHOP in advanced stage nodular lymphocyte-predominant Hodgkin lymphoma. Blood. 2017 Jul 27;130(4):472-477. Epub 2017 May 18. [https://doi.org/10.1182/blood-2017-02-766121 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5578726/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/28522441/ PubMed]
 ==R-CVP {{#subobject:41e37c|Regimen=1}}==
-{| class="wikitable" style="float:right; margin-left: 5px;"
-|-
-|[[#toc|back to top]]
-|}
 R-CVP: '''<u>R</u>'''ituximab, '''<u>C</u>'''yclophosphamide, '''<u>V</u>'''incristine, '''<u>P</u>'''rednisone
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:c15033|Variant=1}}===
-*[[Rituximab (Rituxan)]] 375 mg/m2 IV once on day 1
+<div class="toccolours" style="background-color:#b3e2cd">
-*[[Cyclophosphamide (Cytoxan)]] 750 mg/m2 IV once on day 1
+====Targeted therapy====
-*[[Vincristine (Oncovin)]] 1.4 mg/m2 (maximum dose of 2mg per cycle) IV once on day 1
+*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
-*[[Prednisone (Sterapred)]] 40 mg/m2 PO once daily on days 1 to 5
+====Chemotherapy====
+*[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV once on day 1
-'''21-day cycles x up to 8 cycles''' (number of cycles for R-CVP in NLPHL is not well-established)
+*[[Vincristine (Oncovin)]] 1.4 mg/m<sup>2</sup> (maximum dose of 2 mg) IV once on day 1
+====Glucocorticoid therapy====
+*[[Prednisone (Sterapred)]] 40 mg/m<sup>2</sup> PO once per day on days 1 to 5
+'''21-day cycle for up to 8 cycles''' (number of cycles for R-CVP in NLPHL is not well-established)
+</div></div>
 ===References===
 See [[#CVP|references for CVP]]
 ==R-EPOCH {{#subobject:f0ac25|Regimen=1}}==
-{| class="wikitable" style="float:right; margin-left: 5px;"
-|-
-|[[#toc|back to top]]
-|}
 R-EPOCH: '''<u>R</u>'''ituximab, '''<u>E</u>'''toposide, '''<u>P</u>'''rednisone, '''<u>O</u>'''ncovin (Vincristine), '''<u>C</u>'''yclophosphamide, '''<u>H</u>'''ydroxydaunorubicin (Doxorubicin)
-===Regimen #1, Wilson et al. 1993 - original EPOCH protocol (which did not include rituximab) {{#subobject:1f818a|Variant=1}}===
+<div class="toccolours" style="background-color:#eeeeee">
-*[[Rituximab (Rituxan)]] 375 mg/m2 IV once per cycle (usually given as outpatient due to reimbursement issues)
+===Regimen variant #1, Wilson et al. 1993 - original EPOCH protocol (which did not include rituximab) {{#subobject:1f818a|Variant=1}}===
-*[[Etoposide (Vepesid)]] 50 mg/m2/day (200 mg/m2 total) IV continuous infusion on days 1 to 4
+<div class="toccolours" style="background-color:#b3e2cd">
-*[[Prednisone (Sterapred)]] 60 mg/m2/day PO on days 1 to 5 (regimen originally was days 1 to 6, but now is just days 1 to 5)
+====Targeted therapy====
-*[[Vincristine (Oncovin)]] 0.4 mg/m2/day (1.6 mg/m2 total) (sometimes capped at maximum total dose of 2mg per cycle) IV continuous infusion on days 1 to 4
+*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per cycle (usually given as outpatient due to reimbursement issues)
-*[[Doxorubicin (Adriamycin)]] 10 mg/m2/day (40 mg/m2 total) IV continuous infusion on days 1 to 4
+====Chemotherapy====
-*[[Cyclophosphamide (Cytoxan)]] 750 mg/m2 IV over 15 minutes on day 5 (regimen originally was day 6, but now is day 5)
+*[[Etoposide (Vepesid)]] 50 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 200 mg/m<sup>2</sup>)
+*[[Vincristine (Oncovin)]] 0.4 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 1.6 mg/m<sup>2</sup>, sometimes capped at maximum total dose of 2 mg per cycle)
-Supportive medications:
+*[[Doxorubicin (Adriamycin)]] 10 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 40 mg/m<sup>2</sup>)
-*PCP prophylaxis (choose one)
+*[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV over 15 minutes once on day 5 (regimen originally was day 6, but now is day 5)
-**[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (160/800 mg) PO BID 3 days per week
+====Glucocorticoid therapy====
-**[[Atovaquone (Mepron)]] 1500 mg PO daily
+*[[Prednisone (Sterapred)]] 60 mg/m<sup>2</sup>/day PO on days 1 to 5 (regimen originally was days 1 to 6, but now is just days 1 to 5)
-**[[Pentamidine (Nebupent)]] 300 mg nebulized Q28days
+====Supportive therapy====
-*[[Filgrastim (Neupogen)]] 5 mcg/kg SQ daily start day 6 and continue until ANC >5,000/uL past nadir
+*PCP prophylaxis with one of the following:
+**[[Trimethoprim-Sulfamethoxazole (Bactrim DS)]] 160/800 mg PO twice per day 3 days per week
-'''21-day cycles x 6 to 8 cycles'''
+**[[Atovaquone (Mepron)]] 1500 mg PO once per day
+**[[Pentamidine (Nebupent)]] 300 mg nebulized once every 28 days
-===Regimen #2, Wilson et al. 2002 - dose-adjusted EPOCH {{#subobject:f46430|Variant=1}}===
+*[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day, started on day 6 and continued until ANC greater than 5000/μL past nadir
-*[[Rituximab (Rituxan)]] 375 mg/m2 IV once per cycle (usually given as outpatient due to reimbursement issues)
+'''21-day cycle for 6 to 8 cycles'''
-*[[Etoposide (Vepesid)]] 50 mg/m2/day (200 mg/m2 total) IV continuous infusion on days 1 to 4
+</div></div><br>
-*[[Prednisone (Sterapred)]] 60 mg/m2 PO BID on days 1 to 5
+<div class="toccolours" style="background-color:#eeeeee">
-*[[Vincristine (Oncovin)]] 0.4 mg/m2/day (1.6 mg/m2 total) (not capped in the paper, but sometimes capped at a maximum total dose of 2mg per cycle) IV continuous infusion on days 1 to 4
+===Regimen variant #2, Wilson et al. 2002 - dose-adjusted EPOCH {{#subobject:f46430|Variant=1}}===
-*[[Doxorubicin (Adriamycin)]] 10 mg/m2/day (40 mg/m2 total) IV continuous infusion on days 1 to 4
+<div class="toccolours" style="background-color:#b3e2cd">
-*[[Cyclophosphamide (Cytoxan)]] 750 mg/m2 IV over 15 minutes on day 5
+====Targeted therapy====
+*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per cycle (usually given as outpatient due to reimbursement issues)
-Supportive medications:
+====Chemotherapy====
-*PCP prophylaxis (choose one)
+*[[Etoposide (Vepesid)]] 50 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 200 mg/m<sup>2</sup>)
-**[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (160/800 mg) PO BID 3 days per week
+*[[Vincristine (Oncovin)]] 0.4 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 1.6 mg/m<sup>2</sup>, sometimes capped at maximum total dose of 2 mg per cycle)
-**[[Atovaquone (Mepron)]] 1500 mg PO daily
+*[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV over 15 minutes once on day 5
-**[[Pentamidine (Nebupent)]] 300 mg nebulized Q28days
+*[[Doxorubicin (Adriamycin)]] 10 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 40 mg/m<sup>2</sup>)
-*[[Filgrastim (Neupogen)]] 5 mcg/kg SQ daily start day 6 and continue until ANC >5,000/uL past nadir
+====Glucocorticoid therapy====
+*[[Prednisone (Sterapred)]] 60 mg/m<sup>2</sup> PO twice per day on days 1 to 5
-'''21-day cycles x 6 to 8 cycles'''
+====Supportive therapy====
+*PCP prophylaxis with one of the following:
-===Dose-adjusted R-EPOCH protocol===
+**[[Trimethoprim-Sulfamethoxazole (Bactrim DS)]] 160/800 mg PO twice per day 3 days per week
+**[[Atovaquone (Mepron)]] 1500 mg PO once per day
+**[[Pentamidine (Nebupent)]] 300 mg nebulized once every 28 days
+*[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day, started on day 6 and continued until ANC greater than 5000/μL past nadir
+'''21-day cycle for 6 to 8 cycles'''
+</div>
+<div class="toccolours" style="background-color:#fff2ae">
+====Dose and schedule modifications====
 *Start cycle 1 as described above
 *Obtain twice per week CBCs for nadir measurements
-*If nadir ANC >500, increase etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle.
+*If nadir ANC greater than 500/μL, increase etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle.
-*If nadir ANC <500 on 1 or 2 measurements, use same doses as last cycle
+*If nadir ANC less than 500/μL on 1 or 2 measurements, use same doses as last cycle
-*If nadir ANC <500 on at least 3 measurements, decrease etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle.
+*If nadir ANC less than 500/μL on at least 3 measurements, decrease etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle.
-*And/or if nadir platelet count <25 on at least 1 measurement, decrease etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle.
+*And/or if nadir platelet count less than 25 x 10<sup>9</sup>/L on at least 1 measurement, decrease etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle.
-*'''Dose adjustments below the cycle 1 starting dose only applies to cyclophosphamide.'''  The lowest etoposide and doxorubicin would be dosed at is the original cycle 1 dose.
+*'''Dose adjustments below the cycle 1 starting dose only applies to cyclophosphamide.''' The lowest etoposide and doxorubicin would be dosed at is the original cycle 1 dose.
-*Can start new cycle Q21days if ANC >1,000 and platelets >100.  If counts are below those levels, check daily CBC and continue growth factor support until counts are adequate and next cycle can start.
+*Can start new cycle Q21days if ANC greater than 1000/μL and platelets greater than 100 x 10<sup>9</sup>/L. If counts are below those levels, check daily CBC and continue growth factor support until counts are adequate and next cycle can start.
+====Dose modifications, historic dose adjustments for hematologic toxicity====
-===Historic dose adjustments for hematologic toxicity===
 These adjustments were in the original paper for standard EPOCH, which are much less relevant due to growth factor support.
 <br>If ANC on day 1 is:
-* >1,500, full dose cyclophosphamide
+* Greater than 1500/μL, full dose cyclophosphamide
-* 1,000-1,500, reduce cyclophosphamide by 187 mg/m2 (equal to 25% dose reduction)
+* 1000 to 1500/μL, reduce cyclophosphamide by 187 mg/m<sup>2</sup> (equal to 25% dose reduction)
-* <1,000, hold EPOCH
+* less than 1000/μL, hold EPOCH
-*If ANC nadir is <500, reduce cyclophosphamide an additional 187 mg/m2
+*If ANC nadir is less than 500/μL, reduce cyclophosphamide an additional 187 mg/m<sup>2</sup>
-*If ANC nadir is >500 and patient had previously been dose-reduced, increase cyclophosphamide dose by 187 mg/m2
+*If ANC nadir is greater than 500/μL and patient had previously been dose-reduced, increase cyclophosphamide dose by 187 mg/m<sup>2</sup>
+</div></div>
 ===References===
 See [[#EPOCH|references for EPOCH]]
+==Rituximab monotherapy {{#subobject:be5153|Regimen=1}}==
-==Rituximab (Rituxan) {{#subobject:be5153|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
-{| class="wikitable" style="float:right; margin-left: 5px;"
+===Regimen {{#subobject:c26f73|Variant=1}}===
+{| class="wikitable sortable" style="width: 60%; text-align:center;"
+!style="width: 33%"|Study
+!style="width: 33%"|Dates of enrollment
+!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
 |-
-|[[#toc|back to top]]
+|[https://doi.org/10.1182/blood.v101.2.420 Rehwald et al. 2003]
-|}
+|1999-2002
-===Regimen #1 (4-week course) {{#subobject:c26f73|Variant=1}}===
+|style="background-color:#91cf61"|Phase 2
-{| border="1" style="text-align:center;" !align="left"
-|'''Study'''
-|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 |-
-|[http://bloodjournal.hematologylibrary.org/content/101/11/4285.long Rehwald et al. 2003]
+|[https://doi.org/10.1182/blood-2002-08-2644 Ekstrand et al. 2003]
-|<span
+|1999-2002
-style="background:#EEEE00;
+|style="background-color:#91cf61"|Phase 2
-padding:3px 6px 3px 6px;
-border-color:black;
-border-width:2px;
-border-style:solid;">Phase II</span>
 |-
-!colspan="4" align="center"|
+|[https://doi.org/10.1200/jco.2013.53.2069 Advani et al. 2014 (U2082N)]
+|1999-2006
+|style="background-color:#91cf61"|Phase 2
 |-
-|[http://bloodjournal.hematologylibrary.org/content/101/11/4285.long Ekstrand et al. 2003]
+|[https://doi.org/10.1182/blood-2011-06-361055 Eichenauer et al. 2011 (GHSG RIPL)]
-|<span
+|2006-2007
-style="background:#EEEE00;
+|style="background-color:#91cf61"|Phase 2
-padding:3px 6px 3px 6px;
-border-color:black;
-border-width:2px;
-border-style:solid;">Phase II</span>
-|-
-!colspan="4" align="center"|
-|-
-|[http://jco.ascopubs.org/content/32/9/912.full Advani et al. 2014]
-|<span
-style="background:#eeee00;
-padding:3px 6px 3px 6px;
-border-color:black;
-border-width:2px;
-border-style:solid;">Phase II</span>
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
+====Targeted therapy====
+*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per day on days 1, 8, 15, 22
+====Supportive therapy====
+*[[Acetaminophen (Tylenol)]] 650 mg PO once per day on days 1, 8, 15, 22; 30 minutes prior to rituximab
+*[[Diphenhydramine (Benadryl)]] 25 mg PO once per day on days 1, 8, 15, 22; 30 minutes prior to rituximab
+'''4-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
+====Subsequent treatment====
+*U2082N, after protocol amendment: [[#Rituximab_monotherapy_2|Rituximab]] maintenance
+</div></div>
+===References===
+# Rehwald U, Schulz H, Reiser M, Sieber M, Staak JO, Morschhauser F, Driessen C, Rudiger T, Muller-Hermelink K, Diehl V, Engert A; German Hodgkin Lymphoma Study Group (GHSG). Treatment of relapsed CD20+ Hodgkin lymphoma with the monoclonal antibody rituximab is effective and well tolerated: results of a phase 2 trial of the German Hodgkin Lymphoma Study Group. Blood. 2003 Jan 15;101(2):420-4. [https://doi.org/10.1182/blood.v101.2.420 link to original article] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/12509381/ PubMed]
+## '''Update:''' Schulz H, Rehwald U, Morschhauser F, Elter T, Driessen C, Rüdiger T, Borchmann P, Schnell R, Diehl V, Engert A, Reiser M. Rituximab in relapsed lymphocyte-predominant Hodgkin lymphoma: long-term results of a phase 2 trial by the German Hodgkin Lymphoma Study Group (GHSG). Blood. 2008 Jan 1;111(1):109-11. Epub 2007 Oct 15. [https://doi.org/10.1182/blood-2007-03-078725 link to original article] '''dosing details in abstract have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/17938252/ PubMed]
+# Ekstrand BC, Lucas JB, Horwitz SM, Fan Z, Breslin S, Hoppe RT, Natkunam Y, Bartlett NL, Horning SJ. Rituximab in lymphocyte-predominant Hodgkin disease: results of a phase 2 trial. Blood. 2003 Jun 1;101(11):4285-9. Epub 2003 Feb 13. [https://doi.org/10.1182/blood-2002-08-2644 link to original article] '''dosing details in abstract have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/12586628/ PubMed]
+# '''GHSG RIPL:''' Eichenauer DA, Fuchs M, Pluetschow A, Klimm B, Halbsguth T, Böll B, von Tresckow B, Nogová L, Borchmann P, Engert A. Phase 2 study of rituximab in newly diagnosed stage IA nodular lymphocyte-predominant Hodgkin lymphoma: a report from the German Hodgkin Study Group. Blood. 2011 Oct 20;118(16):4363-5. Epub 2011 Aug 9. [https://doi.org/10.1182/blood-2011-06-361055 link to original article] '''dosing details in abstract have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/21828141/ PubMed] [https://clinicaltrials.gov/study/NCT00346684 NCT00346684]
+<!-- Presented in part at the 49th Annual Meeting of the American Society of Hematology (ASH), Atlanta, GA, December 8-11, 2007, and 53rd Annual Meeting of ASH, San Diego, CA, December 10-13, 2011. -->
+# '''U2082N:''' Advani RH, Horning SJ, Hoppe RT, Daadi S, Allen J, Natkunam Y, Bartlett NL. Mature results of a phase II study of rituximab therapy for nodular lymphocyte-predominant Hodgkin lymphoma. J Clin Oncol. 2014 Mar 20;32(9):912-8. Epub 2014 Feb 10. [https://doi.org/10.1200/jco.2013.53.2069 link to original article] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/24516013/ PubMed] [https://clinicaltrials.gov/study/NCT00003820 NCT00003820]
-*[[Rituximab (Rituxan)]] 375 mg/m2 IV once per week x 4 weeks
+=Maintenance after upfront therapy=
+==Rituximab monotherapy {{#subobject:8353c7|Regimen=1}}==
-Supportive medications:
+<div class="toccolours" style="background-color:#eeeeee">
-*[[Acetaminophen (Tylenol)]] 650 mg PO 30 minutes prior to each dose of [[Rituximab (Rituxan)]]
+===Regimen {{#subobject:587056|Variant=1}}===
-*[[Diphenhydramine (Benadryl)]] 25 mg PO 30 minutes prior to each dose of [[Rituximab (Rituxan)]]
+{| class="wikitable sortable" style="width: 60%; text-align:center;"
+!style="width: 33%"|Study
-'''One course of 4 week therapy'''
+!style="width: 33%"|Dates of enrollment
+!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
-===Regimen #2, with maintenance {{#subobject:587056|Variant=1}}===
-{| border="1" style="text-align:center;" !align="left"
-|'''Study'''
-|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 |-
-|[http://jco.ascopubs.org/content/32/9/912.full Advani et al. 2014]
+|[https://doi.org/10.1200/jco.2013.53.2069 Advani et al. 2014 (U2082N)]
-|<span
+|1999-2006
-style="background:#ff0000;
+|style="background-color:#ffffbe"|Phase 2, fewer than 20 patients in this arm
-padding:3px 6px 3px 6px;
-border-color:black;
-border-width:2px;
-border-style:solid;">Phase II, <20 patients in this arm</span>
 |-
 |}
+<div class="toccolours" style="background-color:#cbd5e8">
-*[[Rituximab (Rituxan)]] 375 mg/m2 IV once per week x 4 weeks
+====Preceding treatment====
+*[[#Rituximab_monotherapy|Rituximab]] induction x 4
-'''One course, followed by maintenance:'''
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
-*[[Rituximab (Rituxan)]] 375 mg/m2 IV once per week x 4 weeks
+====Targeted therapy====
+*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per day on days 1, 8, 15, 22
-'''One course every 6 months x 2 years'''
+'''6-month cycle for 4 cycles (2 years)'''
+</div></div>
 ===References===
-# Rehwald U, Schulz H, Reiser M, Sieber M, Staak JO, Morschhauser F, Driessen C, Rudiger T, Muller-Hermelink K, Diehl V, Engert A; German Hodgkin Lymphoma Study Group (GHSG). Treatment of relapsed CD20+ Hodgkin lymphoma with the monoclonal antibody rituximab is effective and well tolerated: results of a phase 2 trial of the German Hodgkin Lymphoma Study Group. Blood. 2003 Jan 15;101(2):420-4. [http://bloodjournal.hematologylibrary.org/content/101/11/4285.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/12509381 PubMed]
-## '''Update:''' Schulz H, Rehwald U, Morschhauser F, Elter T, Driessen C, Rüdiger T, Borchmann P, Schnell R, Diehl V, Engert A, Reiser M. Rituximab in relapsed lymphocyte-predominant Hodgkin lymphoma: long-term results of a phase 2 trial by the German Hodgkin Lymphoma Study Group (GHSG). Blood. 2008 Jan 1;111(1):109-11. [http://bloodjournal.hematologylibrary.org/content/111/1/109.long link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/17938252 PubMed]
-# Ekstrand BC, Lucas JB, Horwitz SM, Fan Z, Breslin S, Hoppe RT, Natkunam Y, Bartlett NL, Horning SJ. Rituximab in lymphocyte-predominant Hodgkin disease: results of a phase 2 trial. Blood. 2003 Jun 1;101(11):4285-9. [http://bloodjournal.hematologylibrary.org/content/101/11/4285.long link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/12586628 PubMed]
 <!-- Presented in part at the 49th Annual Meeting of the American Society of Hematology (ASH), Atlanta, GA, December 8-11, 2007, and 53rd Annual Meeting of ASH, San Diego, CA, December 10-13, 2011. -->
-# Advani RH, Horning SJ, Hoppe RT, Daadi S, Allen J, Natkunam Y, Bartlett NL. Mature Results of a Phase II Study of Rituximab Therapy for Nodular Lymphocyte-Predominant Hodgkin Lymphoma. J Clin Oncol. 2014 Mar 20;32(9):912-8. Epub 2014 Feb 10. [http://jco.ascopubs.org/content/32/9/912.full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/24516013 PubMed]
+# '''U2082N:''' Advani RH, Horning SJ, Hoppe RT, Daadi S, Allen J, Natkunam Y, Bartlett NL. Mature results of a phase II study of rituximab therapy for nodular lymphocyte-predominant Hodgkin lymphoma. J Clin Oncol. 2014 Mar 20;32(9):912-8. Epub 2014 Feb 10. [https://doi.org/10.1200/jco.2013.53.2069 link to original article] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/24516013/ PubMed] [https://clinicaltrials.gov/study/NCT00003820 NCT00003820]
+[[Category:Hodgkin lymphoma, nodular lymphocyte-predominant regimens]]
-[[Category:Chemotherapy regimens]]
+[[Category:Disease-specific pages]]
-[[Category:Malignant hematology regimens]]
+[[Category:Indolent lymphomas]]
-[[Category:Lymphoma regimens]]

Difference between revisions of "Hodgkin lymphoma, nodular lymphocyte-predominant"

Latest revision as of 23:38, 15 July 2024

Guidelines

JCO "Oncology Grand Rounds"

NCCN

Untreated

ABVD

Regimen

Chemotherapy

References

CHOP

Regimen

Chemotherapy

Glucocorticoid therapy

References

CVP (Vinblastine/Prednisolone)

Regimen

Chemotherapy

Glucocorticoid therapy

References

EPOCH

Regimen variant #1, Wilson et al. 1993 - original EPOCH protocol

Chemotherapy

Glucocorticoid therapy

Supportive therapy

Regimen variant #2, Wilson et al. 2002 - dose-adjusted EPOCH

Chemotherapy

Glucocorticoid therapy

Supportive therapy

Dose and schedule modifications

References

R-CHOP

Regimen

Targeted therapy

Chemotherapy

Glucocorticoid therapy

References

R-CVP

Regimen

Targeted therapy

Chemotherapy

Glucocorticoid therapy

References

R-EPOCH

Regimen variant #1, Wilson et al. 1993 - original EPOCH protocol (which did not include rituximab)

Targeted therapy

Chemotherapy

Glucocorticoid therapy

Supportive therapy

Regimen variant #2, Wilson et al. 2002 - dose-adjusted EPOCH

Targeted therapy

Chemotherapy

Glucocorticoid therapy

Supportive therapy

Dose and schedule modifications

Dose modifications, historic dose adjustments for hematologic toxicity

References

Rituximab monotherapy

Regimen

Targeted therapy

Supportive therapy

Subsequent treatment

References

Maintenance after upfront therapy

Rituximab monotherapy

Regimen

Preceding treatment

Targeted therapy

References

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